Bruises, Burns, and Other Blemishes: Diagnostic Considerations of Physical Abuse

Bruises and burns are often early signs of child physical abuse that, if unrecognized and/or unreported, can lead to additional injuries and, ultimately, poor outcomes. The emergency physician is in the position to recognize signs of abuse, diagnose, treat, and intervene on behalf of the child to help ensure protection from further harm. In children with bruising and burns suspicious for physical abuse, concomitant occult injuries such as fractures, abdominal injury, and brain injury are common and therefore must be considered. This article uses cases to illustrate the approach to cutaneous injury in children and emphasizes the importance of including physical abuse as part of the differential diagnosis in young children with injuries.